James Hereford – A #Lean COO from Stanford Becomes a Lean CEO at Fairview Health


I've known James Hereford about ten years or so, when we first crossed paths in Lean healthcare circles. I really respect and admire James and his approach to leadership.

I've seen him move and rise from a VP at Group Health to Chief Operating Officer at Stanford Health… and he was named, late last year, to his first CEO position:

Fairview Health Services selects James Hereford to be next CEO
James Hereford, currently of Stanford Health Care, will take over the position in December.

I think I first “met” him when he was part of a group podcast discussion I did with him, Lee Fried, and Dr. Ted Eytan when they were all leading the Lean effort at Group Health Cooperative in Seattle (all of them have moved on to other things):

Group Health Cooperative Lean Leaders and Executive Panel Discussion – LeanBlog Podcast #23

When I was working for the Lean Enterprise Institute and the Healthcare Value Network, I had a chance to meet James in person a number of times… visiting and learning from Group Health Cooperative.

I blogged about that here:

What is Group Health Doing about Waste in Healthcare? A Lot!

James was quoted then as saying:

“Traditional health care often relies on heroic individuals to somehow make a fragmented nonsystem work — instead of having a thoughtfully designed system that makes it easy for doctors, nurses, and other clinicians to provide care. Clinicians shouldn't have to be heroic. The system should remove inefficiencies and unwarranted variation. Allowing highly trained people to work with less waste in more supportive environments will improve quality and reduce costs. That's our long-term commitment and strategy using Lean principles. Over the next five years, we'll make significant gains in efficiency and quality that will really drive a better price point in the marketplace.”

I also had the chance to see him when he presented at or attended the annual Lean Healthcare Transformation Summits (join me there this June).

I posted some notes from his talk at the 2014 Summit, which has a lot of insight:

Day 2 Notes: Lean Healthcare Transformation Summit 2014

And James was mentioned in this post, where he expressed a preference for using Japanese words in the practice of Lean…

An Interesting Take on the Use of Japanese Terms in Lean

It's Hereford's preference to use the original terms. His succinct defense:

“When you go to a Japanese restaurant, do you order sushi or do you say something like, ‘Please get me raw fish rolled in a leaf and rice?'”

OK, that's the rundown on my past posts with or about James.

Here's a new article from the Minneapolis Star-Tribune paper about James and his approach:

Schafer: Fairview's new CEO sees perfection as the goal
A quick read through the background of any new CEO an organization recruits from the outside provides a pretty good indication of the direction the board thinks it needs to go.

A few highlights from that column, by Lee Schafer, follow.

“At the big health care company Fairview Health Services, the board of directors late last year selected James Hereford as CEO. He's a health system executive who once taught statistical process control at Boeing and who now is eager to show his Fairview colleagues a big automotive air bag factory in northern Utah so good at quality management that it's approaching perfection.”

Back to the Lean Healthcare Transformation Summit, I'll be teaching a day-long workshop on how to apply statistical process control to our performance metrics… something I think is a very important topic for healthcare. James is one of the few execs I've met who understands this and other key Deming principles, yet alone Lean.

I've had a chance to visit that Utah air bag factory… it's Autoliv, as discussed in the column. I've been there with healthcare leaders who have been impressed with their approach for work that is also a matter of life and death.

Schafer continues:

“Hereford is far from the only health care executive who has looked at the quality systems that have come out of manufacturing and seen plenty of application in how health care gets delivered. The way he has been introducing the idea at Fairview is not as some sort of new ­corporate goal, though, but as a tool kit or way to help Fairview achieve its goals.”

Except I'm sure that James realizes it's not “a tool kit” — it's a different way of leading and managing.

“Hearing about lean management from the new boss maybe is off-putting to some Fairview staff, but one of the first things anyone learns starting training for lean is that there's usually nothing wrong with the people working in an organization. What is broken is the system of directing the work they do. The other thing that should come up right away is basically no more complicated than finding things that waste time and money and getting rid of them.”

That's the important thing that James understands. The problem is not the staff. The problem is systems, processes, management approaches, and culture. I'm sure James will directly lead this transformation and improvement effort rather than delegating it as many executives do.

James added:

“You know there's a lot of waste in health care,” ­Hereford said. “Maybe the biggest waste is the waste of the human potential of the people who work in it.”

Please do read the whole column.

There are some other challenges… he is the fifth CEO in five years at Fairview. Let's hope he has a longer, more successful tenure.

He also has to navigate the announced merger with HealthEast, whose CEO, Kathryn Correia, is formerly of ThedaCare and is a great Lean leader. It will be interesting to see how the combination of their leadership affects things…

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Thanks Mark for the post. James is a good friend and the best of the best leader I have ever worked with. I cannot wait to see the good work he will do and we can learn from!


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